Presented at the annual meeting of the American Society for Therapeutic
Radiology and Oncology, Boston, MA, October 2000.
Barbara Fowble *A, Alexandra Hanlon *? *?, Gary Freedman *, Nicos Nicolaou *
and Penny Anderson *
[*]Department of Radiation Oncology and, Fox Chase Cancer Center,
Philadelphia, PA, USA[?]Division of Population Science, Department of
Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA
A Reprint requests to: Barbara Fowble, M.D., Department of Radiation Oncology,
Fox Chase Cancer Center, 7701 Burholme Avenue, Philadelphia, PA 19111. Tel:
(215) 728-3053; Fax: (215) 214-1629
Manuscript received 2 January 2001 Revised 3 May 2001 Accepted 10 May 2001;

  Abstract

Purpose: To assess the risk and patterns of second malignancy in a group of
women treated with conservative surgery and radiation in a relatively
contemporary manner for early-stage invasive {*filter*} cancer, and to identify a
subgroup of these women at increased risk for a second cancer.

Methods and Materials: From 1978 to 1994, 1,253 women with unilateral Stage
I-II {*filter*} cancer underwent wide excision, axillary dissection, and
radiation. The median follow-up was 8.9 years, with 446 patients followed for
10 years. The median age was 55 years. Sixty-eight percent had T1 tumors and
74% were axillary-node negative. Radiation was directed to the {*filter*} only in
78%. Adjuvant therapy consisted of chemotherapy in 19%, tamoxifen in 19%, and
both in 8%. Factors analyzed for their association with the cumulative
incidence of all second malignancies, contralateral {*filter*} cancer, and
non-{*filter*} cancer malignancy were: age, menopausal status, race, family
history, obesity, smoking, tumor size, location, histology, pathologic nodal
status, region(s) treated with radiation, and the use and type of adjuvant
therapy.

Results: One hundred seventy-six women developed a second malignancy (87
contralateral {*filter*} cancers at a median interval of 5.8 years, and 98
non-{*filter*} cancer malignancies at a median interval of 7.2 years). Nine women
had both a contralateral {*filter*} cancer and non-{*filter*} cancer second
malignancy. The 5- and 10-year cumulative incidences of a second malignancy
were 5% and 16% for all cancers, 3% and 7% for contralateral {*filter*} cancer, 3%
and 8%, for all second non-{*filter*} cancer malignancies, and 1% and 5%,
respectively, for second non-{*filter*} cancer malignancies, excluding skin
cancers. Patient age was a significant factor for contralateral {*filter*} cancer
and non-{*filter*} cancer second malignancy. Young age was associated with an
increased risk of contralateral {*filter*} cancer, while older age was associated
with an increased the risk of a second non-{*filter*} cancer second malignancy. A
positive family history increased the risk of contralateral {*filter*} cancer, but
not non-{*filter*} cancer malignancies. The risk of a contralateral {*filter*} cancer
increased as the number of affected relatives increased. Tamoxifen resulted in
a nonsignificant decrease in contralateral {*filter*} cancer and an increase in
non-{*filter*} cancer second malignancies. The 5-and 10-year cumulative incidences
for leukemia and lung cancer were 0.08% and 0.2%, and 0.8% and 1%,
respectively. There was no significant effect of chemotherapy or the regions
treated with radiation on contralateral {*filter*} cancer or non-{*filter*} cancer
second malignancy. The most common types of second non-{*filter*} cancer
malignancies were skin cancers, followed by gynecologic malignancies
(endometrial), and gastrointestinal malignancies (colorectal and pancreas).

Conclusion: The 10-years cumulative incidence of a second cancer in this study
was 16%. Young age and family history predicted for an increased risk of
contralateral {*filter*} cancer, and older age predicted for an increased risk of
non-{*filter*} cancer malignancy. The majority of patients treated with
conservative surgery and radiation with or without adjuvant systemic therapy
will not develop a second cancer. Long-term follow-up is important to document
the risk and patterns of second cancer, and knowledge of this risk and the
patterns will influence surveillance and prevention strategies.<sinp>

Very long url, got an error and had to ccp each line at the end of the prior,
so hope you don't mind if I copied/pasted the whole article here.
J

NB: Nine women had both a contralateral {*filter*} cancer and non-{*filter*} cancer
second malignancy. <snip>
What does contralateral mean?

--

            _o                   Kristofer Dale,
         _ \<,_                  ragged individualist,
   _____( )/ ( )_____            statistic at large...

p.s. Learn and live, http://www.***.com/